HFMA CRCR EXAM LATEST EXAM WITH 170+ QUESTIONS
AND CORRECT ANSWERS(VERIFIED ANSWERS) 2025/2026.
Through what document does a hospital establish compliance standards? -
CORRECT ANSWER✔✔ code of conduct
What is the purpose OIG work plant? - CORRECT ANSWER✔✔ Identify
Acceptable compliance programs in various provider setting
If a Medicare patient is admitted on Friday, what services fall within the three-
day DRG window rule? - CORRECT ANSWER✔✔ Non-diagnostic service
provided on Tuesday through Friday
What does a modifier allow a provider to do? - CORRECT ANSWER✔✔
Report a specific circumstance that affected a procedure or service without
changing the code or its definition
IF outpatient diagnostic services are provided within three days of the
admission of a Medicare beneficiary to an IPPS (Inpatient Prospective Payment
System) hospital, what must happen to these charges - CORRECT
ANSWER✔✔ They must be billed separately to the part B Carrier
what is a recurring or series registration? - CORRECT ANSWER✔✔ One
registration record is created for multiple days of service
What are nonemergency patients who come for service without prior
notification to the provider called? - CORRECT ANSWER✔✔ Unscheduled
patients
1|P age
,Which of the following statement apply to the observation patient type? -
CORRECT ANSWER✔✔ It is used to evaluate the need for an inpatient
admission
which services are hospice programs required to provide around the clock
patient - CORRECT ANSWER✔✔ Physician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do what? -
CORRECT ANSWER✔✔ Complete the scheduling process correctly based
on service requeste
The Time needed to prepare the patient before service is the difference between
the patients arrival time and which of the following? - CORRECT
ANSWER✔✔ Procedure time
Medicare guidelines require that when a test is ordered for a LCD or NCD
exists, the information provided on the order must include: - CORRECT
ANSWER✔✔ Documentation of the medical necessity for the test
What is the advantage of a pre-registration program - CORRECT
ANSWER✔✔ It reduces processing times at the time of service
What date are required to establish a new MPI(Master patient Index) entry -
CORRECT ANSWER✔✔ The responsible party's full legal name, date of
birth, and social security number
Which of the following statements is true about third-party payments? -
CORRECT ANSWER✔✔ The payments are received by the provider from
the payer responsible for reimbursing the provider for the patient's covered
services.
2|P age
, Which provision protects the patient from medical expenses that exceed the pre-
set level - CORRECT ANSWER✔✔ stop loss
what documentation must a primary care physician send to HMO patient to
authorize a visit to a specialist for additional testing or care? - CORRECT
ANSWER✔✔ Referral
Under EMTALA (Emergency Medical Treatment and Labor Act) regulations,
the provider may not ask about a patient's insurance information if it would
delay what? - CORRECT ANSWER✔✔ Medical screening and stabilizing
treatment
Which of the following is a step in the discharge process? - CORRECT
ANSWER✔✔ Have a case management service complete the discharge plan
The hospital has a APC based contract for the payment of outpatient services.
Total anticipated charges for the visit are $2,380. The approved APC payment
rate is $780. Where will the patients benefit package be applied? - CORRECT
ANSWER✔✔ To the approved APC payment rate
A patient has met the $200 individual deductible and $900 of the $1000 co-
insurance responsibility. The co-insurance rate is 20%. The estimated insurance
plan responsibility is $1975.00. What amount of coinsurance is due from the
patient? - CORRECT ANSWER✔✔ $100.00
When is a patient considered to be medically indigent? - CORRECT
ANSWER✔✔ The patient's outstanding medical bills exceed a defined
dollar amount or percentage of assets.
What patient assets are considered in the financial assistance application? -
CORRECT ANSWER✔✔ Sources of readily available funds , vehicles,
campers, boats and saving accounts
3|P age
AND CORRECT ANSWERS(VERIFIED ANSWERS) 2025/2026.
Through what document does a hospital establish compliance standards? -
CORRECT ANSWER✔✔ code of conduct
What is the purpose OIG work plant? - CORRECT ANSWER✔✔ Identify
Acceptable compliance programs in various provider setting
If a Medicare patient is admitted on Friday, what services fall within the three-
day DRG window rule? - CORRECT ANSWER✔✔ Non-diagnostic service
provided on Tuesday through Friday
What does a modifier allow a provider to do? - CORRECT ANSWER✔✔
Report a specific circumstance that affected a procedure or service without
changing the code or its definition
IF outpatient diagnostic services are provided within three days of the
admission of a Medicare beneficiary to an IPPS (Inpatient Prospective Payment
System) hospital, what must happen to these charges - CORRECT
ANSWER✔✔ They must be billed separately to the part B Carrier
what is a recurring or series registration? - CORRECT ANSWER✔✔ One
registration record is created for multiple days of service
What are nonemergency patients who come for service without prior
notification to the provider called? - CORRECT ANSWER✔✔ Unscheduled
patients
1|P age
,Which of the following statement apply to the observation patient type? -
CORRECT ANSWER✔✔ It is used to evaluate the need for an inpatient
admission
which services are hospice programs required to provide around the clock
patient - CORRECT ANSWER✔✔ Physician, Nursing, Pharmacy
Scheduler instructions are used to prompt the scheduler to do what? -
CORRECT ANSWER✔✔ Complete the scheduling process correctly based
on service requeste
The Time needed to prepare the patient before service is the difference between
the patients arrival time and which of the following? - CORRECT
ANSWER✔✔ Procedure time
Medicare guidelines require that when a test is ordered for a LCD or NCD
exists, the information provided on the order must include: - CORRECT
ANSWER✔✔ Documentation of the medical necessity for the test
What is the advantage of a pre-registration program - CORRECT
ANSWER✔✔ It reduces processing times at the time of service
What date are required to establish a new MPI(Master patient Index) entry -
CORRECT ANSWER✔✔ The responsible party's full legal name, date of
birth, and social security number
Which of the following statements is true about third-party payments? -
CORRECT ANSWER✔✔ The payments are received by the provider from
the payer responsible for reimbursing the provider for the patient's covered
services.
2|P age
, Which provision protects the patient from medical expenses that exceed the pre-
set level - CORRECT ANSWER✔✔ stop loss
what documentation must a primary care physician send to HMO patient to
authorize a visit to a specialist for additional testing or care? - CORRECT
ANSWER✔✔ Referral
Under EMTALA (Emergency Medical Treatment and Labor Act) regulations,
the provider may not ask about a patient's insurance information if it would
delay what? - CORRECT ANSWER✔✔ Medical screening and stabilizing
treatment
Which of the following is a step in the discharge process? - CORRECT
ANSWER✔✔ Have a case management service complete the discharge plan
The hospital has a APC based contract for the payment of outpatient services.
Total anticipated charges for the visit are $2,380. The approved APC payment
rate is $780. Where will the patients benefit package be applied? - CORRECT
ANSWER✔✔ To the approved APC payment rate
A patient has met the $200 individual deductible and $900 of the $1000 co-
insurance responsibility. The co-insurance rate is 20%. The estimated insurance
plan responsibility is $1975.00. What amount of coinsurance is due from the
patient? - CORRECT ANSWER✔✔ $100.00
When is a patient considered to be medically indigent? - CORRECT
ANSWER✔✔ The patient's outstanding medical bills exceed a defined
dollar amount or percentage of assets.
What patient assets are considered in the financial assistance application? -
CORRECT ANSWER✔✔ Sources of readily available funds , vehicles,
campers, boats and saving accounts
3|P age
